Perceptions Of Firearms In A Cohort Of Women Exposed To .
(2021) 21:20Leuenberger et al. BMC Women’s en AccessRESEARCH ARTICLEPerceptions of firearms in a cohort of womenexposed to intimate partner violence (IPV)in Central PennsylvaniaLaura Leuenberger1* , Erik Lehman2 and Jennifer McCall‑Hosenfeld2,3AbstractBackground: Almost one-half of U.S. women will experience intimate partner violence (IPV), defined as physical,sexual, or psychological harm by a current or former partner. IPV is associated with an increased risk of homicide, withfirearms as the most commonly used weapon. We designed this study to better understand the correlation of inter‑personal trauma exposures and demographic factors on firearm perceptions among a cohort of IPV-exposed women.Methods: Two hundred sixty-seven women in central Pennsylvania with exposure to IPV were surveyed aboutperceptions of gun access, safety, and gun presence in the home. Trauma variables included IPV type, IPV recency,unwanted sexual exposure, and adverse childhood experiences (ACEs). Multivariable analyses examined three ques‑tions examining firearm perceptions controlling for trauma exposures and demographics.Results: Ease of firearm acquisition: Women who were older (mean 44.92 years / SD 12.05), compared to womenwho were younger (40.91 / SD 11.81 years) were more likely to describe it as easy or very easy to acquire a gun(aOR 1.05, 95%CI 1.004, 1.10).Perceived safety in the proximity of a gun: Women with the highest ACE score were less likely to feel safe with a gunnearby (aOR 0.31, 95%CI 0.14, 0.67).Odds of guns in the home: Women who were divorced or separated (aOR 0.22, 95%CI 0.09, 0.54), women were wid‑owed or single (aOR0.23, 95%CI 0.08, 0.67), and women who were partnered (aOR 0.45 95%CI 0.20, 0.97) had lowerodds of having a gun in the home, compared to married women. There was no significant effect of the trauma vari‑ables on the odds of having a gun at home.Conclusions: Women with more severe childhood trauma felt less safe around firearms, but trauma exposures didnot predict the perception of gun prevalence in the local community or gun ownership. Instead, demographic factorsof marriage predicted presence of a gun in the home.Keywords: Partner abuse, Abuse, Violence, Domestic violence, Gun violence, Battered women, HomicideBackgroundNearly half (48%) of U.S. women experience intimatepartner violence (IPV)—“physical violence, sexual violence, stalking and psychological aggression by a current*Correspondence: leuenber@med.umich.edu1Department of Internal Medicine, University of Michigan, 338 CatherineSt, Apt 1, Ann Arbor, MI 48104, USAFull list of author information is available at the end of the articleor former intimate partner” [1]. One-quarter of womenexposed to IPV sustain an injury from a partner, andIPV is the most common cause of nonfatal injury amongwomen [2, 3]. Furthermore, women with a history of IPVare more likely to be homicide victims. Forty percentof femicides are perpetrated by an intimate partner, themajority with a firearm [4]. Research has consistentlyshown that the presence of guns increases the risk of a The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, whichpermits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to theoriginal author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images orother third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit lineto the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutoryregulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of thislicence, visit http://creat iveco mmons .org/licen ses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creat iveco mmons .org/publi cdoma in/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Leuenberger et al. BMC Women’s Health(2021) 21:20Page 2 of 9woman being murdered [4, 5], despite the political expediency of a popular narrative, promoted by the firearmindustry, citing guns to be empowering for women’s selfdefense [6].In times of personal stress and natural disasters, intimate partner violence rates increase, as do rates of intimate partner homicide [7]. Most recently, the stressposed by the COVID-19 (novel coronavirus) pandemic,are anecdotally linked and temporally correlated withinternationally increasing rates of intimate partner violence and homicide [8]. As the world attempts to slowthe spread of this virus, movements to “Stay Home” arepredicated on “home” being a safe place.In the US context, gun prevalence in a community correlates to higher rates of IPV, although this associationis confounded by regional and state variability. Rates offirearm-related IPV are highest in the states with highest firearm prevalence. Overall, there is a trend towardexcess female mortality in states with high availability offirearms [9]. Many states have IPV-related firearm laws,most of which aim to prevent perpetrators of domesticviolence from purchasing firearms; other states allow orrequire the removal of already owned firearms by police.States with laws removing guns from IPV perpetratorshave lower rates of intimate partner related homicide[10]. These data are difficult to interpret however, givenstate level variability in both the laws themselves andtheir enforcement. For example, some states requireremoval of a perpetrator’s firearm only if the gun hasbeen used to threaten the victim, while others require theabuser to be arrested [11]. Laws which prevent individuals who have a restraining order filed against them fromowning or purchasing a firearm have been correlatedwith decrease in intimate partner homicide [12].Despite the risks posed by firearms to IPV-exposedwomen, little is known about gun ownership and accessin this population. Qualitative research on the topichas explored how women with a history of exposure toIPV feel, noting a diversity of opinions. Some orted feeling danger when a partner had a gun, noting that the firearm could be a constant threat within therelationship. Other women perceived that a gun mightprotect them from an abuser [13, 14].While there are demographics factors known to correlate to gun ownership, such as marriage and rurality[15], it is not known if these same factors are associatedwith proximity to a gun in high risk women, or if traumaexposures in these women affect their perceptions ofguns. The National Gun Policy Survey of the NationalOpinion Research Center has shown that the possessionof a firearm is strongly associated with living in a ruralarea as well as with being married [11, 16]. Furthermore,gun ownership appears to vary by race [11]. Age hasbeen shown as a correlate of gun ownership, as Americans under 35 years old were less likely to own a gunthan adults over 65 years old [11]. Increased householdincome correlated positively with ownership in the literature [11].To understand if these correlates applied in a high-riskcohort of IPV-exposed women, we first reviewed the literature examining factors influencing firearm ownershipand opinions about firearm safety to create a conceptualmodel for this study. Our conceptual model, created outof this literature review and shown in Fig. 1, characterizesgun ownership and opinions about firearm safety andaccess as being governed by two major categories: demographics and trauma exposures.Given the increased mortality risk firearms pose towomen who have a history of IPV, this study seeks tounderstand how this high-risk cohort perceives guns, andif the same factors that govern popular sentiment applyto this population. To help to understand these questions, we examined a cohort of IPV-exposed women withrespect to perceptions of accessibility to firearms in theircommunities, perceptions of safety with a gun nearby,and the presence of firearms in the home. IPV victims’perceptions were the focus of our analysis because victims are uniquely qualified to assess their own risk ofPerceived Ease to acquire a GunPerception of Safety around a GunUrbanicityMarital StatusPresence of a Firearm in the HomeEducationFig. 1 Conceptual Model of Factors Shaping IPV-Exposed Women’s Perceptions of FirearmsTrauma FactorsIPV Exposure TypeRecency of IPVUnwanted SexualExposureAdverse ChildhoodExperiences
Leuenberger et al. BMC Women’s Health(2021) 21:20lethality; that is, women who believe they are at increasedrisk of violence, are, in fact, at increased risk [5, 17]. Wedesigned this study to contribute to an understandingof what factors are associated with perceptions of gunsamong victims of IPV and other interpersonal traumas, in hopes that clinicians and policymakers can helpwomen to mitigate their risks.MethodsSample selectionThe sample identification protocols for this study havebeen previously published [18]. The cohort was recruitedbetween Fall 2013 and Spring 2014 in south central Pennsylvania, USA. Women were eligible for inclusion if theyscreened positive for a lifetime history of IPV based onthe humiliation-afraid-rape-kick (HARK) screeninginstrument, a validated 4-item screen to identify IPV inhealthcare settings [19], and left their contact information after completing the screening questionnaire (Additional file 1: Screener Survey). Participants subsequentlycompleted the Baseline Survey (Additional file 2: Baseline Survey). Data collection for the 1 year follow up tookplace between Fall 2014 and Spring 2015 (Additionalfile 3: One Year Follow Up Survey).Briefly, we identified a sample of 24,338 women ages18-64 in south central Pennsylvania with least one primary care visit in the past year. A randomly selected subset of 2,500 women were invited to participate; surveyswere received from 1,191 women from the clinical sample. The sample was stratified for rural residence usingthe zip-code based approximation of the Rural-UrbanCommuting Area codes, a classification system based oncity size and commuting practices [20]. Rural-residingwomen were oversampled to achieve appropriate numbers for analysis. To augment the cohort drawn fromthe healthcare setting, posters were also displayed at 26domestic violence shelters in Central Pennsylvania, inviting women to participate in the survey online, by phone,or by mail. From this population, an additional 73 womenwere recruited to participate in response to these posters,yielding the final sample size of 1264 women who completed the screening survey.Among this sample, those women who screened positive for lifetime exposure to IPV based on the humiliation-afraid-rape-kick (HARK) screening instrument, avalidated 4-item screen to identify IPV in healthcare settings [19] and who left their contact information werecontacted with an invitation to participate in a longitudinal study, requiring completion of a survey at baselineand one year later.Of the women recruited via the ambulatory cohort, 500women screened positive for IPV, and 270 participatedin the baseline survey. From the participants recruitedPage 3 of 9from the shelter sample, 60 women screened positive forIPV, and 38 participated in the baseline survey. These twosubgroups were treated identically after initial recruitment. After 1 year, all women who completed the baseline survey were contacted and asked to complete thefollow up survey. Among the women completing the follow up survey, 239 from the ambulatory cohort and 28shelter participants (for a total 267 women) participatedin the one-year follow-up survey. These 267 women formthe analytic cohort for this analysis.Study data were entered and managed within REDCap(Research Electronic Data Capture), a secure, web-basedapplication designed to support data capture for researchstudies, hosted by Pennsylvania State University [21].This study was conducted with approval from the Institutional Review Board (IRB) for all study protocol andstudy documents. All women reviewed a written or verbal informed consent and consented to participate in thisresearch. To protect participants further, and due to thesensitive nature of this study, a Certificate of Confidentiality (CC-MH-12-204) was obtained from the NationalInstitutes of Health for this research.Variables of interestThe follow up cohort of 267 women was assessed for thethree primary outcomes surrounding firearms, of 1) perceptions of access (“How easy is it for people who livenear you to get a gun?”), 2) perceptions of safety (“Doeshaving a gun around make you feel safer or less safe?”),and 3) firearm proximity (“Are any firearms kept in oraround your home?”) [16, 22]. As noted in Fig. 1, wehypothesized that trauma exposures would affect perceptions of firearm safety, in that women with a history oftrauma would feel less safe around guns, be less likely tohave guns in the home, and perceive guns to be readilyavailable in their community.Our primary independent variables were demographics and trauma exposures. To assess prior history oftrauma, participants were screened for IPV recency(past-year vs. lifetime) and IPV type (physical vs nonphysical) using HARK [19]. Nonphysical IPV (humiliate-afraid) and physical IPV (rape-kick) were mutuallyexclusive categories, and participants were stratifiedinto the physical IPV category if they had ever experienced physical IPV. The HARK question stem was modified to determine whether they had experienced IPV intheir lifetimes compared to the past year. Additionalinterpersonal trauma exposures were unwanted sexualexposure [23] and adverse childhood experiences [24].“Unwanted sexual exposure” was categorized as never,lifetime, or past-year [23]. “Adverse childhood experiences” (ACEs) were stratified by severity into tertiles.ACEs were determined using a definition taken from
Leuenberger et al. BMC Women’s Health(2021) 21:20the ACE study (a collaborative research endeavorfunded by the CDC and Kaiser Permanente [24].To control for variation in the sample by demographics, we evaluated our cohort for age, marital status, urbanicity, poverty, education, and race/ethnicity.These variables were chosen because of their relevanceto IPV, as well as their role in gun ownership trends.We considered whether our patients were near poverty(defined as 125% of the national poverty line) or notnear poverty. Gun ownership also varies with regionof the country, but our cohort is from within the sameregional area, so we were unable to account for thisvariation.Data analysisAll variables were summarized with frequencies andpercentages. Binomial or ordinal logistic regression,depending on the format of the outcome variable, wasused to determine any unadjusted bivariate associationsbetween each of the demographic and trauma exposurevariables and each of the three firearm perception questions. Covariates were selected and retained for inclusionin the model based on their relationship to the outcomesvariables as seen in the literature. As there were very fewmissing data, these were not included in analyses. We didnot infer any missing data.As noted above, significant data exists on the demographic variables associated with gun ownership, especially surrounding age, race/ethnicity, rurality, maritalstatus, education, and income. Given that our outcomesvariables included questions of guns in the home and alsogun perceptions, we considered that these demographicvariables were likely predictors of our outcome variablesto be included in our analyses. To assess the relationshipof gun ownership and perceptions with types of interpersonal trauma, we looked at different types of IPV, recencyof IPV, unwanted sexual exposure, and ACEs to evaluateif these traumas were related to our outcomes variables.Interactions were not specifically tested in this model.Multivariable analyses examined the associations ofthese exposure variables collectively with each of thethree firearm perception questions while controlling forthe demographic variables. All of the independent variables were tested for multicollinearity prior to inclusionin the model using variance inflation factor (VIF) statistics, and the fit of the multivariable models was assessedusing the Pearson, Deviance, and Hosmer and Lemeshowgoodness-of-fit tests. If the majority of these tests showedgood model fit with p 0.05, we accepted the model ashaving good fit, and this was the case for all three multivariable models. All analyses used a significance level ofp 0.05 and were performed using SAS version 9.4 [25].Page 4 of 9ResultsAs seen in Table 1, among the 266 respondents, the meanage was 44.48 years, with 89% identifying as white, nonHispanic. Only 17% of this cohort were at or near poverty (income less than 150% the US poverty line). Of thecohort, 46% resided in urban areas, and 48% were married. Sixty-five percent experienced physical IPV; 21%reported IPV within the past year. For unwanted sexualexposure, 58% had been exposed in their lifetime. Almostone third of this cohort (32%) had experienced 4-10Adverse Childhood Experiences. Bivariate data revealedsignificance in the relationship between marital statusand the presence of a gun in the home. Also significantwere the relationships between feeling unsafe arounda firearm and the cohort with the highest number ofAdverse Childhood Experiences.Multivariable analyses are shown in Table 2, notingboth significant and not significant associations. Womenwho were older (aOR 1.05, 95% CI 1.004, 1.097) weremore likely to report guns to be easy to acquire in theircommunities. Analysis of perceived safety in the proximity of a gun showed significance in the relationshipof women with the highest ACE score, indicating a highlevel of childhood trauma, to be less likely to feel safewith a gun nearby (versus those with the lowest ACEscore, aOR 0.31, 95% CI 0.36–1.58).Multivariable analysis showed no significant association between any of the trauma exposure variablesand having a gun at home. However, women who weredivorced or separated (aOR 0.22, 95% CI 0.09–0.54),women who were partnered (aOR 0.45, 95% CI 0.20–0.97), and women who were widowed or single (aOR0.23, 95% CI 0.08–0.67) had lower odds of having a gunin the home, compared to married women.DiscussionThis study used quantitative analyses of survey data toexplore how demographics and interpersonal traumasrelate to IPV-exposed women’s perceptions of firearms.These analytic targets were chosen because women witha history of IPV are at high risk for violent injury. Ourmajor findings were that a) older women perceived gunsto be more accessible in their community, b) women witha high level of childhood trauma were less likely to feelsafe with a gun nearby, and c) there was no associationbetween trauma exposure and presence of a gun in thehome.Our finding that women with a high level of childhood trauma felt less safe near a gun, suggesting that aheightened perception of risk after trauma may extendfrom childhood to adulthood, was concordant with ourhypothesis. Of note, firearms have never been shown tohave a protective effect for women in violent intimate
35 (87%)62 (23%)84 (32%)119 (45%)High school or lessSome CollegeCollege Graduate47 (82%)145 (87%)149 (58%)96 (37%)78 (3%)82 (32%)LifetimeT1 (0-1)T2 (2-3)T3 (4-10)94 (37%)14 (5%)Never211 (79%)NoPast Year56 (21%)5 (13%)8 (10%)9 (12%)15 (16%)18 (12%)1 (8%)13 (14%)25 (12%)9 (17%)22 (13%)12 (14%)14 (12%)10 (13%)9 (15%)1 (3%)10 (18%)18 (15%)5 (11%)20 (14%)14 (12%)24 (12%)0.500.770.410.940.860.330.570.900.65128 (55%)53 (65%)42 (55%)49 (51%)85 (57%)11 (79%)46 (49%)120 (57%)29 (52%)98 (57%)51 (55%)63 (53%)50 (60%)35 (56%)24 (75%)36 (61%)53 (42%)35 (74%)72 (51%)76 (63%)112 (54%)29 (69%)19 (68%)**“Overall” percentages refer to those of the column (the entire study cohort); Specific variable column percents refer to the row71 (90%)64 (88%)78 (83%)126 (88%)12 (92%)77 (86%)177 (88%)45 (83%)Physical (Rape-Kick)Yes174 (65%)77 (86%)Non Physical (Humiliate- 93 (35%)Afraid)101 (88%)69 (87%)51 (85%)29 (97%)60(23%)32 (12%)PartneredWidowed/ Single42 (89%)103 (85%)47 (18%)127 (48%)Divorced/ Separated118 (86%)102 (88%)179 (88%)31 (14%)3 (11%)mean (SD)29 (35%)34 (45%)47 (49%)63 (43%)3 (21%)47 (51%)89 (43%)27 (48%)75 (43%)41 (45%)55 (47%)33 (40%)27 (44%)8 (25%)23 (39%)73 (58%)12 (26%)70 (49%)45 (37%)96 (46%)13 (31%)9 (32%)106 (45%)n (%)129 (58%)83 (61%)60 (53%)114 (57%)23 (55%)13 (46%)0.180.110.450.850.6333 (41%)47 (64%)57 (66%)77 (53%)4 (31%)59 (69%)119 (60%)24 (44%)95 (57%)48 (57%)61 (55%)46 (58%)35 (58%)14 (48%)36 (60%)71 (60%) 0.01* 22 (50%)0.05*0.070.19p-value n (%)43.24 (12.34)p-value mean (SD)44.85 (12.19) 44.06 (12.18) 0.60p-value n (%)0.07p-value mean (SD)48 (59%)27 (36%)29 (34%)68 (47%)9 (69%)27 (31%)79 (40%)30 (56%)73 (43%)36 (43%)50 (45%)33 (42%)25 (42%)15 (52%)24 (40%)47 (40%)22 (50%)54 (39%)53 (47%)85 (43%)19 (45%)15 (54%)92 (42%)n (%)45.54 (11.86)mean (SD) p-value(2021) 21:20* Significant using p-value of 0.05Adverse childhoodeventsUnwanted sexualexposurePast year exposureto IPVLifetime IPV exposuretype194 (86%)25 (89%)Married121 (46%)144 (54%)YesNo42 (17%)210 (83%)YesNoInterpersonal trauma variablesEducationMarital statusUrbanNear poverty236 (89%)28 (11%)Non-Hispanic whitenon-whiteRace/ Ethnicityn (%)n (%)n (%)mean (SD)40.91 (11.81)mean (SD)Very Safe/ Safe SomewhatLess Safe/ VeryUnsafeYesVery Easy/ Easy Hard/ ImpossibleNoDoes having a gun around make you feelmore or less safe?How easy is it for people who live near you Are any firearms keptto get a gun?in or around your home?44.48 (12.13) 44.92 (12.05)mean (SD)n 266Age in yearsDemographic variablesOverall**Table 1 Trauma and demographic variables relating to firearm perceptions in a cohort of IPV-exposed womanLeuenberger et al. BMC Women’s HealthPage 5 of 9
Leuenberger et al. BMC Women’s Health(2021) 21:20Page 6 of 9Table 2 Multivariate odds ratios of firearms perceptions among women with a history of exposure to intimate partnerviolence“How easy is it for people who livenear you to get a gun?”a“Are any firearms keptin or around your home?”b“Does having a gunaround make you feelsafer or less safe?”caOR95% CIaOR95% CIaOR95% CI1.05(1.00, 1.10)*1.00(0.97, 1.03)0.99(0.96, 1.02)(0.17, 3.12)1.29(0.48, 3.43)1.60(0.63, 4.11)(0.28, 4.52)0.99(0.40, 2.43)1.24(0.52, 2.95)(0.31, 1.97)0.66(0.36, 1.22)0.86(0.46, spanic White0.72Near povertyNot near povertyReferenceNear poverty1.12UrbanUrbanReferenceNot urban0.78Marital statusMarriedReferenceDivorced/separated1.66(0.42, 6.56)0.22(0.09, 0.54)*0.77(0.34, 1.74)Partnered1.81(0.58, 5.62)0.45(0.20, 0.97)*0.93(0.14, 2.08)Widowed/single6.27(0.68, 58.12)0.23(0.08, 0.67)*0.40(0.14, 1.09)EducationCollege graduateReferenceHigh school or less0.52(0.15, 1.83)0.94(0.43, 2.08)1.26(0.56, 2.84)Some college0.82(0.27, 2.43)0.66(0.32, 1.34)1.38(0.66, 2.88)(0.60, 4.33)1.14(0.58, 2.24)1.68(0.83, 3.40)(0.16, 1.23)1.40(0.68, 2.88)0.73(0.35, 1.50)Lifetime IPV exposure typeNon physical (humiliate-afraid)ReferencePhysical (rape-kick)1.61Past year exposure to IPVNoReferenceYes0.45Unwanted sexual exposureNeverReferencePast year1.47(0.14, 15.97)0.39(0.08, 1.83)0.31(0.07, 1.31)Lifetime0.61(0.22, 1.72)0.96(0.47, 1.93)0.60(0.29, 1.26)Adverse childhood eventsa0–1 eventsReference2–3 events1.28(0.46, 3.60)0.77(0.38, 1.55)0.75(0.36, 1.58)4–10 events2.72(0.76, 9.71)0.68(0.32, 1.45)0.31(0.14, 0.67)*Higher aOR indicates “easier”bHigher aOR indicates “Yes”cHigher aOR indicates “safer”*Indicates significant odds ratiospartner relationships [4]; indeed, the opposite is true.Despite this, 57% of our sample of IPV-exposed womenfelt having a gun around made them feel at least somewhat safer, this is similar to the 58% of American women(compared to 67% of American men) who think a gunmakes them feel “safer” in 2015 [26, 27].Regarding guns in the home, the various trauma exposure variables (IPV type, recency, unwanted sexual exposure and childhood adverse events) did not correlate withthe presence of a gun in the home. Nationally, 30-40%of households in the US report having a firearm [15], soour cohort has a higher rate of gun ownership (44%) than
Leuenberger et al. BMC Women’s Health(2021) 21:20the national average. Consistent with national trends,gun ownership was most correlated with demographicvariables [15]. The high rate of firearms at home amongIPV-exposed women may represent an area for intervention among professionals who encounter IPV-exposedwomen.Together, our findings suggest that some trauma exposures likely impact how safe IPV-exposed women feelaround guns, and yet are not reflected in whether or notthey live in a home with a gun. Other influences governproximity to a gun at home, which may prevent womenfrom controlling their safety at home.Strengths and limitations of this studyCompared to other studies on this topic and in this population, a strength of this study is its size, and a samplingstrategy that expanded the population of IPV victimsfrom exclusively recruiting at shelters, to investigating the experiences of those seeking care from primaryhealthcare settings. Given the prevalence of IPV, thissampling method likely represents more diverse experiences among IPV-exposed women. Most other studieson this topic have recruited from only domestic violenceshelters, which may represent a subset of women with adifferent pattern of violence than other IPV victims [28].A weakness in this analysis is that the specific owner ofthe guns at home were unknown and could be the survey participant, a partner, or housemate; from our data,we were unable to determine if a current relationshipreflected that of an abuser. While this study is larger thanprevious studies, it remains too small to effectively identify a large number of associations. Further study shouldbe done to better characterize gun ownership in this population. We were also limited by our regional cohort, asgun opinions and ownership vary with geographic regionof residence. Due to the limited racial and ethnic diversity in the cohort (although reflective of the larger population in the community sampled), we were unable toanalyze by specific racial categories. Also limiting is ourinitial response rate from our participants recruited fromthe ambulatory care cohort, with an initial 2500 surveysresulting in 1191 responses (a response rate of 47.6%),concerning for potential for non-response bias; we areunable to know if non-responders varied in any significant way from responders. Unfortunately, we were unable to perform sensitivity analysis, given the lack of dataon the non-responding group. This study only addressesfemale victims of IPV, while not addressing male victims;this focus is due to the increased risk of injury suffered byfemale as compared to male victims of IPV [29].Page 7 of 9ConclusionsThis analysis may help to understand in the Americancontext surrounding gun safety. The ultimate goal wouldbe to inform policies which make women safer. Firearmsare the most common form of weapon for intimate partner homicide in the U.S., but not in other high incomecountries [30]. International data from these high incomecountries, shows that overall female homicide andgun availability cluster together, with the U.S. being anextreme outlier in both [31]. An abusive partner’s accessto a firearm in the home is associated with more severeIPV [30]. Understanding the risks that firearms pose inunsafe homes is increasingly important as the ongoingpersonal, political, and economic stresses wrought by the2020 pandemic are unlikely to resolve in the near future.As a public health practitioners, providers and policymakers must address the disconnect between havinga gun in the home and the risks faced by IPV-exposedwomen. This study emphasizes the importance inempowering women to make decisions that make themsafer and less likely victims of intimate partner violenceand homicide. Furthermore, these findings are concordant with policies which remove guns from IPV perpetrators, which have been correlated to reduction in intimatepartner homicide [10]. This study supports policies whichhelp to educate women about their risks and to providethem with resources to make safe decisions as needed.This novel study examined the perceptions of guns andrisk by IPV-exposed women. Women with a trauma history are at an elevated risk for mortality from firearms,and can only be appropriately counselled if the risks areknown. This data should inform public policy surrounding counseling women about intimate partner violenceand gun ownership.By understanding this, we hope to inform the debatessurrounding intimate partner violence and gun ownership. Evidence suggests that limiting gun access of abusers decreases the number of intimate partner homicides[32]. Furthermore, it is important to understand the risksfaced by these women, so they can be counselled appropriately to reduce these risks. The physician’s office is aplace where women may seek help, and may providean opportunity for intervention and prevention; IPVexposed women have higher healthcare utilization thannon IPV-exposed women [33, 34]. As such, strategiesto engage women in their risks, and to understand theirperspectives, would be valuable resources to decrease therisk of intimate partner violence, and ultimately intimatepartner homicide.
Leuenberger et al. BMC Women’s Health(2021) 21:20Supplementary InformationThe online version contains supplementary material available at https ://doi.org/10.1186/s1290 5-020-01134 -y.Additional file 1: Screener survey.Additional file 2: Baseline survey.Additional file 3: One year fo
Perceived safety in the proximity of a gun: Women with the highest ACE score were less likely to feel safe with a gun nearby (aOR 0.31, 95%CI 0.14, 0.67). Odds of guns in the home: Women who were divorced or separated (aOR 0.22, 95%CI 0.09, 0.54), women were wid‑
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